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在已故捐赠者的移植中,平衡晶体溶液与盐水 (BEST-Fluids):实用,双盲,随机,受控试验

Michael G Collins ¹, Magid A Fahim ², Elaine M Pascoe ³

¹Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia; Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia.
²Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia.
³Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia.
⁴Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia; Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, QLD, Australia; Translational Research Institute, Brisbane, QLD, Australia.
⁵Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.
⁶Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia.
⁷Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.
⁸Department of Nephrology, Austin Health, Melbourne, VIC, Australia; Department of Medicine (Austin), University of Melbourne, Melbourne, VIC, Australia.
⁹Department of Anaesthesia, Austin Health, Melbourne, VIC, Australia; Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
¹⁰Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
¹¹Department of Nephrology, Prince of Wales Hospital, Sydney, NSW, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
¹²Department of Nephrology, St Vincent's Hospital, Melbourne, VIC, Australia.
¹³School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, NSW, Australia.
¹⁴Department of Nephrology and Renal Transplantation, Fiona Stanley Hospital, Murdoch, WA, Australia; School of Medicine, University of Western Australia, Perth, WA, Australia.
¹⁵Department of Nephrology, Monash Health, Melbourne, VIC, Australia; Centre for Inflammatory Diseases, Department of Medicine, Monash University, Melbourne, VIC, Australia.
¹⁶Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia.
¹⁷School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
¹⁸Child and Adolescent Renal Service, Queensland Children's Hospital, Brisbane, QLD, Australia.
¹⁹Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia; Department of Renal and Transplantation Medicine, Westmead Hospital, Sydney, NSW, Australia.
²⁰Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand; Department of Medicine, University of Auckland, Auckland, New Zealand.
²¹School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Centre for Transplant and Renal Research, Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia; Department of Renal and Transplantation Medicine, Westmead Hospital, Sydney, NSW, Australia.
²²Kidney Node, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia; Department of Renal Medicine, Kidney Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

⁰Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, SA, Australia; Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Australasian Kidney Trials Network, Centre for Health Services Research, University of Queensland, Brisbane, QLD, Australia.

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2023年六月21日

在PubMed上查看摘要

概括

在移植患者中,使用平衡晶体溶液而不是盐水显著降低了移植功能延迟 (DGF). 这一发现支持平衡晶体作为已故捐赠移植的标准.

科学领域

科和移植手术
危急护理医学
临床药理学

背景情况

在已故捐赠者的移植后,延迟的移植功能 (DGF) 是一个重要的并发症.
常用于维持血管内体积的静脉注射盐水可能会增加DGF的风险,因为含量很高.
该研究调查了平衡的低化物溶液是否可以减轻DGF的发生率.

研究的目的

评估平衡低化物溶液 (Plasma-Lyte 148) 与盐水在移植后降低DGF的有效性.
在已故捐赠者的移植中建立最佳的流体管理策略.

主要方法

一个实用,多中心,双盲,随机对照试验 (BEST-Fluids) 涉及澳大利亚和新西兰的16家医院.
接受已故捐赠者的808名参与者随机接受平衡晶体或盐水.
主要结果是DGF,定义为需要在移植后7天内进行透析;安全性也被评估.

主要成果

与盐酸组相比,平衡晶体组的DGF发病率明显较低 (30%) (调整后的相对风险为0. 74;p< 0. 0001).
这代表了使用平衡晶体的DGF绝对风险降低10.1%.
严重的不良事件在两组之间是相似的,表明可比的安全性.

结论

用平衡晶体溶液静脉注射液疗法有效降低了移植患者的DGF发病率.
均衡的晶体溶液应被视为已故捐赠者移植的标准护理液.

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